The prospect of school is looming. I cannot ignore it any longer. Next September, D moves out of the protective bubble of nursery and into the big wide world of primary school. The application forms need to be in by mid January.
I’m guessing that (given a choice) parents might ordinarily choose a school on the basis of things like proximity to their home, or the OFSTED rating. And those factors are important to me too. However, the deciding vote will be in favour of the school that seems the most clued up about protecting a child with food allergies. So I have embarked on a tour of our local primary schools, both to have a look around and to broach the subject of D’s peanut allergy with the staff.
Once the appointments were in the diary, I realised that I needed to:
- Compile a list of questions to ask the school. However, in order to do this, I first needed to know what measures UK schools typically put in place for allergic children.
- Think about the things I could be doing behind the scenes, both before and after term starts, to make things safer for D (and therefore less stressful for me).
Although I’m still feeling like a novice on the schools front, I thought I would share some of:
- The excellent advice I’ve been given by Nutmums.com readers who have school age children.
- The handy tips I picked up at at a recent Manchester Allergy Support Group meeting on “Food allergy in schools”.
- Links to the other useful resources I’ve found on this topic.
If you’ve already been through starting school with a nut allergy, and have any advice or tactics that may help me and other readers with pre-school children, do post a comment below – I would love to hear from you!
What measures do primary schools put in place for an allergic child?
It seems the starting point is the EAACI position paper from 2010: The management of the allergic child at school. This sets out the following “rights of the allergic child”:
“1. To be educated in a safe and healthy environment, with as few provoking allergens and irritants as possible and to breathe clean air in schools.
2. Not to be stigmatized as a result of their condition.
3. To be able to participate in all educational and recreational school activities to the same extent as their peers.
4. To have access to medication and other measures to relieve symptoms.
5. To have access to trained personnel who are able to treat acute reactions.
6. To have their education adapted to their condition if necessary (e.g. physical education).”
The position paper talks about a “co-operative partnership” between doctors, community and school nurses, parents, the school and the child. It sets out action points for the various parties. So, as parents, for example, we need to:
- Tell the school about D’s allergies and provide the school with a written allergy management plan (obtained from the hospital).
- Provide the school with a set of D’s emergency medication (and keep track of the expiry dates, so I can provide replacement adrenaline auto-injectors when needed).
In turn, the school’s responsibilities include:
- Adopting the written emergency treatment plan.
- Making sure all staff (1) can identify children with allergies and (2) are aware of the location of the children’s (individually labelled) emergency medicine kits.
- Ensuring all staff are trained in allergen avoidance, recognition and treatment of anaphylaxis (with annual refresher training).
For more information on allergy management plans, see Anaphylaxis Campaign, Setting up a management plan, which links to plan templates on the BSACI website.
Will the school be “nut free”?
Selfishly: I would like D’s school to be “nut free”.
Rationally: I know that children have allergies to all sorts of foods, and I can see how making a school milk, egg, soya, wheat etc etc free would be unworkable.
There is also the argument that, by making a school nut free, you create a false sense of security and don’t prepare the nut allergic child for life in the outside world. Although I can see the sense in this, I think there’s something to be said for erring on the side of over-protection for a young child of four or five, compared to a child of, say, ten, who has a completely different level of awareness.
Of the three schools I have visited so far, two have been “nut free”, to the point where they ask parents not to include peanut- or nut-containing foods in packed lunches. The third school said they hadn’t needed to impose a “nut ban”, as it hadn’t yet been an issue: their pupils hadn’t yet brought in peanut butter sandwiches.
Is there a school nurse?
From talking to our local primary schools, it seems that in our area (East Cheshire) each school nurse works for several schools. So, the school nurse isn’t based full time at any one particular school. However, of the three schools I have visited, all aim to make sure that ALL staff (so teachers, teaching assistants, administrative staff, dinner ladies etc) know which children have allergies (and to what allergens), how to recognise an allergic reaction, where the child’s medication is kept and how to administer an adrenaline auto-injector. Music to my ears, to say the least.
What’s safer: school dinners or packed lunches?
In September, the Government announced that all infant school pupils in England will get free school lunches from September 2014 (see the BBC report and the Anaphylaxis Campaign’s response). My first thought was “we’ll stick to packed lunches, thanks all the same”. Then I started wondering: would it be safer for me to put my trust in the school dinner provider, and have D sitting amongst children eating the same food, or send him in with a packed lunch that I knew was safe, but then live in fear of cross-contamination from the child next to him eating a peanut butter sandwich or nutty granola bar?
My fears on this have been allayed somewhat after talking to the various schools. All three had ladies who prepared the school dinners on site, and one said that I could come into school, before D started, to talk to their cook about D’s dietary requirements. The schools also had a “no swaps” rule and had extra staff on hand at lunchtimes to police this.
When I attended the Manchester Allergy Support Group back in October, Judy Stafford (from the Royal Manchester Children’s Hospital) gave an extremely informative talk on “Food allergy in school”. On the school dinners vs packed lunch debate, she suggested thinking about who it was who wanted packed lunches. Was this mum, thinking it was safer? Or actually something the child wanted (maybe for reasons unrelated to allergies)? Could mum’s fears be overcome, if the nut allergic child ate at a “nut free table”? Or, might it even be sufficient for the nut allergic child to have a seat at the end of a table, where it would be easier for the staff to keep an eye out for spills or attempted swaps?
The schools I have visited do not have separate nut free tables. At one of the schools, children could sit wherever they pleased: there was no segregation of those having school dinners and those with packed lunches. I think I will talk to the cook at whichever school we end up, and make a call on this nearer to the time.
Ideas for working with the school
A recurrent theme running through both the position paper and the support group talk is the need to work WITH the school. One Nutmums.com reader told me that she worked with her son’s school to put together a risk assessment, which set out all the steps that his school would take to minimise the risk of an allergic reaction. Her son was diagnosed as peanut and tree nut allergic during the summer holidays before starting Year 4 (ages 8-9). The measures the school put in place (and which I will be using as a guide!) included:
- All staff trained on use of Jext pens.
- Son to take in packed lunch and own snack for playtime.
- Lunchtime staff to be able to identify son, and also ensure his table is wiped down before he sits down to eat at lunchtime (he was taken into the kitchen on the first day of school to say hello to all the dinner ladies!).
- Son’s emergency allergy kit to be placed in office, clearly labelled as his and with his photograph on it (I put together a tupperware containing his Jexts, antihistamines, ‘blue’ inhaler and clear instructions for use plus lots of copies).
- Procedure established for staff to go and get the allergy kit immediately in case of emergency.
- Emergency plan laminated with son’s photograph on it and placed in an obvious place in every classroom and the school kitchen and staffroom (my youngest son told me he has a peep at his big brother’s photo every morning in his classroom before the register is taken!). The emergency plan states … what my son is allergic to, where his emergency kit is kept, how to recognise a reaction and what to do if a reaction occurs. It also sets out a vast array of emergency contact numbers from myself, my husband, grandparents and local auntie and uncle!
- School implementing a “no nut” policy so parents are advised via school newsletter not to include nuts, nut products, peanut butter, nutella etc etc in packed lunches and snacks – this is a massive relief, and has been probably the main factor in allowing me to relax during the day. Parents are to be re-reminded about this at the start of every new term.
- We are to send in bag of allergy friendly snacks so that when other children are handing out treats on birthdays etc, there’s a stash of goodies that my son can have so he doesn’t feel left out.
- We are to be informed in advance of party days/class treats so can liaise with teacher to see what food is going to be provided and send in suitable alternatives if needs be.
- I have to be a ‘parent helper’ on school trips wherever possible.
- Children are also encouraged to wash hands before and after eating.
One other suggestion (from a teacher who herself has allergies), is to provide the teacher with a list of acceptable foods. The teacher would need to check the food label each time, but a “safe list” would give them a starting point if they wanted to do treats.
Feeling daunted? You betcha…
At the moment, if we take D out with his scooter, we have to walk on the outer edge of the pavement and steer him back towards the hedge when he starts veering towards the road. The speed is there, the control isn’t, and neither is there any proper conception of the danger of the oncoming traffic. When I look at older children zipping along on scooters by themselves, it’s difficult to picture D doing the same. I know it will happen. It just seems a long way off.
In the same way, I struggle to picture D saying “no thank you” to a child in a playground who offers him a chocolate biscuit. D knows that nuts will make him poorly (“because I hab allergy”), that we need to check ingredients labels (“check label! no nuts!”) and that he has special medicine if he is ever unwell. But is he at the stage where he would say “no” to a food? I don’t think we’re there yet. But we need to be at that point, in ten months time.
What can we do at home to prepare and plan ahead?
Two key rules…
A reader told me that every morning, she makes her son repeat the following two key rules:
“1 – don’t eat anything that someone else gives him
2 – tell the teacher if he feels any sign of a reaction at all”
I think this is a tactic I will be copying wholesale!
Another suggestion is to build up your child’s allergy awareness generally, for example by talking to your child about checking food labels when supermarket shopping, or by explaining what’s happening at a restaurant (when you are reading a menu and checking the position on allergens with the staff).
Anticipating risk areas
What things at school pose a particular risk for the nut allergic child? And, crucially, what can you do to prepare for them and make them safer?
A key piece of advice which stuck in my mind following Judy Stafford’s support group talk was to always ask “what are the options?”, always looking at the situation from the perspective of what your child CAN do (inclusion) rather than what they CAN’T (exclusion). So, say there is a school party coming up where food is going to be served: what are your options? Well, firstly, you could talk to the school about the party food, as it may be that everything is already nut free. If not, you could:
- Keep your child home that day, so they miss the party altogether.
- Provide a packed lunch for your child to eat, whilst all the other children eat party food.
- Find out what party food will be served, and provide a packed lunch with nut free versions of those foods (as far as possible).
- Offer to do the shopping for the party, so that all of the food is safe for your child and they can dig in and pile food onto their plate like everyone else.
Other common risk areas for food allergic children at school include:
Birthdays. The birthday boy or girl might bring in treats to share with the class. Events such as Halloween and Easter pose a similar risk. One nut mum I know has instilled into her child that Haribos are safe, but anything else is off limits. The position paper suggests that “Food-allergic children may benefit from an individually labelled box, containing allergen-free ‘treat’ foods for class celebrations or rewards”, so it’s worth talking to the school about a treats box and to agree that you will be given a heads up on any impending food-related events.
The home corner. It seems common for infants school classes to have a “home corner”, where children can play house or play shop. Empty food packets are often used as props. One nut mum I know has been very pleased with the comprehensive way in which her sons’ school and nursery have dealt with their allergies, however the school has recently taken to using empty boxes of Crunchy Nut cornflakes as home corner props. Fortunately, her son (aged 5) can recognise the packaging and knows not to play with that particular box. However, I guess if your child was less aware, it would be a case of talking to the teacher and maybe offering to provide alternative props.
Water fountains. Rather than use the water fountain, could your child have bottled water on hand instead?
Sporting events and school trips. For any events where the child is going to be taken out of school (for example, for swimming lessons, to play football against another school, on a school trip), parents need to talk to the teacher in charge beforehand, to check:
- On arrangements for food.
- That both your child’s emergency meds and a person trained to administer them will be on hand.
(see the Anaphylaxis Campaign’s advice on Out-of-school activities).
At the support group talk, Judy Stafford mentioned that you could consider volunteering to be a parent helper, however you need to bear in mind your child’s age, as this can be socially awkward for the child as they get older. Judy also suggested that, if you know there is a residential trip coming up in year 6, you could do some groundwork beforehand, for example:
- Going on school day trips.
- Have sleepovers at grandparents’ or a friend’s house.
At the support group talk, it was suggested that someone could also test your child by offering a peanut-containing snack. (Although that sounds a good idea, when D gets a bit older I think a potential flaw might be if he then holds a grudge against the “tester” as having been trying to poison him!)
Christmas party. See above – you might, for example, send in safe food for your child or get involved in organising the food for everyone.
Cookery lessons. Home economics classes (or whatever they are called now!) sound like a potential food allergy minefield. However, it seems that a food allergic child need not necessarily be excluded from cookery classes or clubs, but there will need to be some discussion with the teacher beforehand as to how things can be made safe. Recipes could be adapted to be nut free. The child with allergies could use their own designated work space and utensils, for example with baking tins which can be easily differentiated (for example, a different shape or colour).
My list of questions for the initial appointment
It has been a relief that all of the schools I have visited so far have had experience of allergic children and already had systems in place to care for pupils with allergies. However, I still have more to visit, and, in case they are less forthcoming, these are the questions I will ask:
- Do you have experience of other children with allergies?
- If D joins your school, will we put together an action plan? What would you like me to provide?
- Can all staff identify those children with allergies? (Do you have their photos on a wall?) Where are their emergency medicines kept?
- Do you have a school nurse? Do all staff know how to use an EpiPen / Jext pen?
- Is the school “nut free”?
- What are the arrangements at lunchtime? Is there a nut free table? Are swaps forbidden?
- As regards school dinners, would it be possible to come in to talk to the cook about D’s dietary requirements?